Development and validation of a nomogram for the risk prediction of malignant cerebral edema after acute large hemispheric infarction involving the anterior circulation

Background Malignant cerebral edema (MCE) is a life-threatening complication of large hemisphere infarction (LHI). Therefore, fast, accurate, and convenient tool for predicting MCE can guide triage services facilitate shared decision-making. In this study, we aimed to develop validate nomogram the early prediction risk in acute LHI involving anterior circulation understand potential mechanism MCE. Methods This retrospective study included 312 consecutive patients with from 1 January 2019 28 February 2023. The were divided into non-MCE groups. was defined as an obvious mass effect ≥5 mm midline shift or basal cistern effacement. Least absolute shrinkage selection operator (LASSO) logistic regression performed explore MCE-associated factors, including medical records, laboratory data, computed tomography (CT) scans, independent clinic factors. factors further incorporated construct prediction. Results Among LHI, 120 developed following eight independently associated MCE: Glasgow Coma Scale score ( p = 0.007), baseline National Institutes Health Stroke 0.006), Alberta Program Early CT Score < 0.001), admission monocyte count 0.004), white blood cell 0.002), HbA1c level (p history hypertension 0.027), atrial fibrillation 0.114). These characteristics used establish prognosis. achieved AUC-ROC 0.89 (95% CI, 0.82–0.96). Conclusion Our based on LASSO-logistic accurate useful after LHI. model serve precise practical clinical decision-making who may require aggressive therapeutic approaches.